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Updates to the TMPPM Durable Medical Equipment Handbook Available September 1, 2024

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

On September 1, 2024, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Durable Medical Equipment Handbook to include the following:

Note: Texas Medicaid fee-for-service requires providers to review for medical necessity of DME every six months. An MCO may approve an initial DME prior authorization request for a period of 6 months, unless otherwise stated, and may authorize an extension of 12 months after the initial 6 months, if medically necessary.”

For more information about prior authorization, providers can refer to the TMPPM, Section 5: Fee-for-Service Prior Authorizations, or contact the appropriate MCO or dental maintenance organization (DMO).

For more information, call the TMHP Contact Center at 800-925-9126.